Neurology and Neuroscience (ISSN 2692-7918) is an open access, peer-reviewed journal, which aims to publish data related to fields of both neurosciences and neurology. The expert articles from researchers and clinical practitioners in the related fields provide in-depth knowledge of the basic and advanced clinical approaches on the on the nervous system and neurological disorders. The journal accepts all types of articles such as research, reviews, mini-reviews, case reports, letters to the editor, and commentaries, reports, etc. providing a single forum for discussion. The journal follows strict double blind peer review process to provide unbiased recognition of the work. All the articles will be freely available online immediately after acceptance. Manuscripts could be submitted through our online portal or as directly to the editorial office as attachment to email at submissions@neurosciencejournal.net
NEURON ON: A Bioactive Moringa Oil Targeting Oxidative Stress and Silent Synapses in Neurological Disorders Including Epilepsy
Recent research into neuronal regeneration for epilepsy has focused on silent, or passive, synapses— synaptic junctions that are anatomically present but electrically inactive. These synapses may serve as potential sites for reactivation and neuronal recovery, especially following injury or disease. "NEURON ON," a novel bioactive moringa oil formulation enriched with CBD and delivered via exogenous exosomes, aims to reduce oxidative stress and reawaken silent synapses. In a proof-of-concept trial, 243 patients with epilepsy (ages 25–75) received personalized sublingual doses of NEURON ON. The oxidative stress coefficient (OSC) was measured using the LONGLIFE OXY-LORD (LLOL) calculator. Results demonstrated that 198 participants (81.48%) showed a 50% reduction in OSC, corresponding to a 90% oxidative stress relief rate. Additionally, patients exhibited an average 12% reduction in estimated biological age. These findings suggest that NEURON ON may promote neuronal regeneration by forming a melanin-like lipid interface that facilitates connectivity among low-activity neurons. Given these outcomes, EEG evaluations are recommended to validate functional neural recovery. NEURON ON holds promise as a personalized oxidative stress-reducing therapy for epilepsy and other oxidative pathologies affecting neuronal connectivity
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Targeted Radioprobe Delivery in Neurology
Nuclear medicine has established an irreplaceable role in the biomedical research and management of brain diseases. Its unique capacity to visualize molecular events in vivo as they unfold provides diagnostic clarity into functional performance and the option for therapeutic intervention. Limitations on access to brain tissue, however, have traditionally restricted nuclear medicine procedures to use of low molecular weight radioligands confined to the extracellular space of the brain, e.g., neurotransmitter receptors, which has precluded the interrogation of many cellular processes likely to be causal in disease etiology. Developments in radioprobe features and targeted delivery over the past two decades are overcoming these limitations, expanding the domain within which dysfunctional processes can be examined. These developments afford the prospect not only of a systemic view of brain diseases but also one likely to be more proximal to the unfolding dysfunctional events
Retrospective Study of 42 Patients Undergoing Vertebroplasty in 2023-2024
Vertebroplasty is a minimally invasive procedure widely used for the treatment of vertebral fractures, particularly in patients with osteoporotic fractures and metastatic tumor infiltration. This study aimed to evaluate the clinical outcomes of vertebroplasty in 42 patients treated between 2023 and 2024. The analysis included variables such as fracture types, the number of treated vertebrae, and postoperative complications. The results indicated a significant reduction in pain, but with an incidence of complications such as segment loss and secondary fractures.
Posterior Approach for Upper Cervical Schwannomas (C1–C2): Two Case Reports and Literature Review
Upper cervical schwannomas at the C1–C2 level are rare and present surgical challenges due to the complex anatomy and proximity to critical neurovascular structures. We present two cases of schwannomas located at the C1–C2 junction treated via a posterior approach. In the first case, a 75-yearold female underwent laminectomy, and in the second, a woman in her 30s underwent laminoplasty. Both surgeries achieved gross total resection with favorable neurological outcomes. We discuss the rationale for the surgical approach, the importance of preserving spinal stability, and the role of individualized decision-making in managing these rare tumors
The Role of Brain Mapping and EEG in Chronic Pain and Neurofeedback Therapy: The BrainView System
Chronic pain and traumatic brain injury (TBI), particularly mild TBI (mTBI), are prevalent neurological conditions that remain difficult to detect and manage using conventional imaging methods. Electroencephalography (EEG), with its portability and high temporal resolution, offers a promising alternative for assessing neural dysfunction—though historically limited by noise, artifacts, and complex interpretation. Recent advances in artificial intelligence (AI)-driven EEG analysis have demonstrated high accuracy in distinguishing chronic pain conditions and show potential for detecting subtle abnormalities associated with mTBI. Additionally, neurofeedback interventions targeting specific EEG frequency bands (e.g., alpha, theta) have been shown to reduce pain intensity and improve functional outcomes in conditions such as spinal cord injury and fibromyalgia. The increasing availability of portable EEG systems also expands access to care for underserved populations. This paper reviews the integration of EEG, quantitative EEG (qEEG), AI, and neurofeedback as emerging tools for the diagnosis and treatment of chronic pain and TBI. We highlight the BrainView system, a non-invasive, portable platform that combines these technologies to provide AI-enhanced EEG analysis, source localization, and neurofunctional assessment. BrainView generates comprehensive neurofunctional response test reports, including brain maps, EEG frequency analysis, evoked potentials (EPs), neurobehavioral assessments, self-report questionnaires, and physician summaries. We also examine recent technical advances, current limitations, and future directions for EEG-based neuromodulation. As a combined system, BrainView and related EEG-based technologies offer a powerful, non-invasive approach to improving diagnosis and treatment, particularly in remote and military healthcare settings
Consciousness and Sleep: Quality Assurance of Rest
Consciousness never sleeps. During sleep consciousness is engaged in quality assurance of rest for the system psyche, nervous system, and other systems of the body through a mammoth of silent activities. Neural correlates of sleep are important but not sufficient to understand sleep. The article discusses several models of the psyche participating in the mechanism of sleep. The models also offer clues how psychic mechanisms could interact with neural mechanisms. Two psycho-maneuvering techniques have been described that help many to have quality sleep.
Hurricane Helene’s Aftermath: A First Responder’s PTSD (A Case Report)
The primary focus of this article is directed towards the rehabilitation and restoration of function in a first responder tasked with identifying and recovering remains from the aftermath of Hurricane Helene. His involvement included operating a heat-seeking drone for identification purposes, as well as a Zodiac boat for the recovery of remains. Regarding his recovery involvement, he identified the deceased mother of a close friend, thereby triggering his PTSD reaction. Salient excerpts from his storm-induced treatment for PTSD are included in the case study section of this article. A binaural sound-based intervention called RESET Therapy (RT) (Reconsolidation Enhancement by Stimulation of Emotional Triggers) has been found to rapidly unlock the emotional aspects of long-term memories of trauma among combat veterans with PTSD. An iPhone version of RT named Resolve-It! has been developed and utilized in this case report. Its purpose is to provide home-based support that exceeds what is available in a traditional office visit. Resolve-It! is a binaural sound generator device used for nonverbal remediation, control, and reduction of varied emotional or physiologically based difficulties. Examples of targeted complications may include stress/anxiety/trauma reactions or other factors such as prolonged grief, pain, or addiction tendencies that are stored in key long-term memory sites in the brain. Within this context, our first responder was treated solely through telehealth for his PTSD condition. Foundational aspects of RT are elucidated, including method and theoretical perspective, as well as essential components of the reconsolidation process. Additionally, current research findings related to the cumulative stress response, including neuroinflammation, trauma, and the use of telehealth, are briefly reviewed.
Personalized Surgical Strategy in Cervical Myelopathy: Case Series with Anterior and Posterior Approaches
Introduction: Cervical myelopathy is a progressive condition that often requires surgical decompression. The anterior and posterior approaches are the most commonly used. The choice should be individualized, based on the number of affected levels, presence of ossification of the posterior longitudinal ligament (OPLL), cervical alignment, and bone quality. Case Series: Three patients underwent posterior approach due to multilevel stenosis, OPLL, and preserved alignment. Laminectomies, with or without fusion, were safe and effective. The other three patients were treated via anterior approach. In cases with soft disc herniation, localized anterior compression, or osteoporosis, anterior cervical discectomy and fusion (ACDF) was chosen, resulting in good functional recovery. Discussion: Surgical decisions must consider the location of compression, disease extent, sagittal alignment, and comorbidities. The posterior approach is preferred in multilevel stenosis with ossification. The anterior approach allows direct decompression in localized compression. Both approaches show similar long-term outcomes when properly indicated. Intraoperative monitoring contributes to surgical safety, as demonstrated in one case. Conclusion: The choice of surgical approach in cervical myelopathy must be individualized. Detailed anatomical and clinical evaluation guides the optimal strategy, aiming for safety and favorable functional outcomes.
Influence of Gut Microbiota on Neurodevelopment: A Literature Review
The gut microbiota plays a crucial role in the development of the central nervous system (CNS) from the gestational period through the early years of life. Growing evidence shows that changes in its composition—known as dysbiosis—are associated with neurological and behavioral disorders such as autism spectrum disorder (ASD), ADHD, and anxiety. This study aims to review the current literature on the relationship between the microbiota and neurodevelopment, highlighting the involved mechanisms, influencing factors, and potential clinical applications. Scientific articles were selected from databases such as PubMed, Scopus, and Web of Science. The findings point to a bidirectional communication between the gut and the brain, mediated by immunological, metabolic, and neuroendocrine pathways, with therapeutic potential through interventions such as probiotics, prebiotics, and fecal microbiota transplantation. It is concluded that modulating the microbiota represents a promising pathway to promote neurological health in children.
Radiation-Induced Cavernoma Progression: Case Report and Literature Review
This article reports a rare case of radiation-induced cavernoma progression in an adult patient following treatment for a brainstem cavernoma. Cavernomas are benign vascular malformations that may occur sporadically or be associated with ionizing radiation. While radiotherapy is effective in treating central nervous system (CNS) tumors and symptomatic cavernomas, it can also induce late adverse effects, such as the formation of new cavernomas. The patient, a 47-year-old man, underwent radiotherapy after experiencing refractory seizures due to a brainstem cavernoma. Initially, clinical improvement was observed, but eight months after treatment, new cavernoma lesions appeared, worsening the clinical picture. Radiotherapy can stabilize existing cavernomas but is also associated with the formation of new ones due to vascular endothelial damage. These effects may manifest years after radiation exposure, with a latency period ranging from 1 to 26 years. Magnetic resonance imaging (MRI) plays a key role in diagnosis and monitoring. Although radiotherapy is a valid option when surgery is contraindicated, long-term follow-up is essential to detect complications and adjust therapeutic strategies.
Proximal Aneurysm of the Anterior Cerebral Artery: Case Report and Literature Review
Introduction: Aneurysms of the proximal segment (A1) of the anterior cerebral artery (ACA) are rare, accounting for approximately 1% of intracranial aneurysms. Associated vascular anomalies, such as fenestration, complicate diagnosis and treatment, requiring careful planning. Case Report: A 51-yearold woman presented with sudden onset headache. Angio-MRI and digital subtraction angiography revealed a saccular aneurysm measuring 16 x 10 mm in the left A1 segment of the ACA, associated with a fenestrated artery. Due to the complex anatomy and risk of perforator artery damage, microsurgical clipping via the pterional approach was chosen. The patient had a favorable outcome, with early discharge and no permanent deficits. Discussion: A1 aneurysms are challenging due to their proximity to critical structures and anatomical variations. Despite the current trend toward endovascular approaches, open surgery remains preferable in cases with a high risk of complications. Conclusion: Treatment of A1 segment aneurysms should be individualized. In complex cases, the microsurgical approach combined with advanced imaging techniques provides good outcomes and greater safety in managing these rare lesions.
Late Migration of Anterior Cervical Prosthesis: A Case Report
Intervertebral disc disease is a common condition affecting the cervical spine, often treated with discectomy combined with anterior cervical fusion. While the technique has low complication rates, rare complications, such as cervical prosthesis migration, can occur even years after the procedure. We present a case of late migration of a cervical prosthesis with significant complications, highlighting the importance of continuous clinical follow-up.
Mild-Type Infantile Acute Subdural Hematoma Followed by Subdural Hematohygroma: Report of A Case Suggesting Common Etiology Causing Acute Subdural Hematoma and Hematohygroma
Background: Infantile acute subdural hematoma (IASDH) and subdural hematohygroma (SDHy) have been seemingly closely related disorders, to date, however, there have been poorly elucidated concerning the etiological relationship. The present case report aimed to approach possible etiology commonly developing both disorders. Case description: A one month-old girl suffered fever associated with poor milk feeding. Because these symptoms failed to subside and the diagnosis was undefinitive, she was transiently hospitalized for sepsis workup. Head CT revealed focal enlargement of subarachnoid space (SAS), and MRI 9 days later showed benign enlargement of subarachnoid space. Two months later, however, she was noted to have generalized convulsive seizure, prompting to refer to a nearby hospital. At the emergency room, although she was alert and asymptomatic, head CT revealed acute subdural hematoma (ASDH). Ophthalmological examination failed to reveal retinal hemorrhage. MRI 9 days later disclosed disappearance of ASDH and newly developed bilateral SDHy. Her clinical course was uneventful, and follow-up CT at the age of 4 months showed enlargement of subarachnoid spaces on both frontotemporal regions and disappearance of SDHy. Discussion and conclusion: In the present case, clinical course and serial neuroimaging findings, particularly CT and MRI at the age of one month undergone as routine sepsis workup without neurological events, are invaluable to elucidate the pathological similarity between IASDH and SDHy. Second CT taken after seizure showed thin film-like ASDH associated with enlargement of SAS, typical features seen in mild-type IASDH. On the other hand, second MRI 9 days after CT revealed disappearance of ASDH, and disclosed bilateral SDHy associated with benign enlargement of subarachnoid space. This phenomenon indicates early disappearance of mild-type IASDH together with progressive enlargement of SAS probably leading to development of SDHy.
Benign enlargement of subarachnoid space
, Large sylvian fissure, Arachnoid rupture
Bipolar Disorder and Beta Frequency Band: Neurophysiological Impacts During the COVID-19 Pandemic
The COVID-19 pandemic posed significant challenges to mental health, particularly for individuals with bipolar disorder. This review study aimed to investigate the relationship between bipolar disorder and electroencephalographic activity in the beta frequency band (13–30 Hz), analyzing its role in attentional and sensorimotor integration processes. The literature indicates that beta activity is associated with alertness and cognitive functions, serving as a potential biomarker for diagnosis and clinical monitoring. During the pandemic, factors such as stress, social isolation, and circadian rhythm disruption intensified the symptoms of the disorder, which were reflected in beta band activity alterations. Furthermore, the methodological variability of the reviewed studies highlights the need for improved experimental paradigms and analytical techniques. These findings emphasize the importance of future research on neurophysiological activity in bipolar patients and therapeutic interventions targeting beta band modulation
Trauma-Informed Leadership: Recognising, Responding, and Rebuilding Organisational Resilience
This article explores trauma-informed leadership within corporate environments, highlighting the relevance of psychological and physiological trauma in shaping workplace behaviours and organisational dynamics. Drawing on interdisciplinary research, it challenges traditional leadership models that prioritise performance metrics over relational understanding, arguing instead for leadership approaches that are responsive to the pervasive impact of trauma. The article examines how trauma can manifest in professional settings - not only through individual behaviours but also in organisational cultures - and considers how systemic factors such as cultural, historical, and intergenerational trauma influence employee experiences. Key principles of trauma-informed leadership are outlined, with a focus on psychological safety, empowerment, and cultural responsiveness. A practical framework is presented to assist leaders in recognising trauma-related behaviours and responding with strategies that foster connection, trust, and resilience. While there is no one-size-fits-all method for addressing trauma in the workplace, this article offers a research-informed foundation for cultivating leadership practices that support individual wellbeing and enhance collective organisational functioning.
Cerebellar Hemangioblastoma in A Patient With Von Hippel-Lindau Syndrome
Von Hippel-Lindau syndrome (VHL) is an autosomal dominant hereditary disease characterized by a variety of benign/malignant tumors, mainly hemangioblastomas, renal, pancreatic, and hepatic alterations, as well as pheochromocytoma. The disease is associated with high morbidity and mortality and can affect multiple family members. Due to the potential for serious complications and psychosocial impacts, early diagnosis is crucial for monitoring tumor lesions, multidisciplinary treatment, and appropriate genetic counseling.
Cranioplasty For Treatment of Syndrome of The Trephined: Case Report And Literature Review
Syndrome of the Trephined (ST) is a neurological complication observed after decompressive craniectomies, characterized by progressive neurological deterioration linked to the removal of a significant portion of the skull. ST commonly occurs in patients with severe traumatic brain injury, stroke, or other conditions causing intracranial hypertension. While rare, its clinical relevance is significant due to the impact on patient recovery. The syndrome's incidence varies depending on the clinical context, with risk factors including hemorrhagic injuries and brain displacement. In Brazil, its prevalence is underreported, partly due to the lack of large studies, though the incidence has risen with the increasing use of decompressive craniectomies in cases of severe intracranial hypertension. We present a case of a 69-year-old male patient with ST after a decompressive craniectomy for acute subdural hematoma and cerebral edema following trauma. Cranioplasty was performed to address the bone defect, and postsurgical recovery showed significant motor improvement, although swallowing difficulties persisted. The primary therapeutic approach for ST is cranioplasty, with early intervention shown to improve neurological outcomes. Early cranioplasty, performed within 30 days of decompressive craniectomy, leads to a recovery rate of up to 75%. This case highlights the importance of timely surgical intervention and the need for further studies on ST, particularly focusing on its epidemiology and pathophysiology in Brazil.
Implementation of CT perfusion as The Ancillary Test of Choice for Neurological Determination of Death: A Qualitative Approach
Background: Accurate neurological determination of death (NDD) is essential in healthcare and often requires several ancillary tests in patients with an ambiguous clinical examination or confounding factors. In the absence of a widely accepted ideal in terms of ancillary tests, this study aims to establish computed tomography perfusion (CTP) as the gold standard test to minimize variability in practice guidelines. Methods: After approval from the institutional research ethics board, the study was conducted in 3 phases: In the first phase of six months, barriers, facilitators, and general attitudes towards CTP were identified among neuroradiologists and critical care physicians, and tailored strategies were developed. After the protocol’s implementation for twelve months in phase 2, final evaluations of strategies were conducted in phase 3 for six months. Family members were also interviewed to discuss their views on NDD and CTP’s role in the decision. Results: Discussions with neuroradiologists and critical care physicians uncovered a general sense of unfamiliarity with CTP, citing the technology’s novelty. However, these feelings of unfamiliarity were found to have reduced after the modality’s implementation for a year. The family members also expressed their desire for certainty regarding NDD and a test with decisive results. Conclusion: With continued open discussions and dedicated education to its adopters, this study indicates CTP to be a promising ideal ancillary test for NDD in the future
Scheuermann's Kyphosis: Case Series and Literature Review
Scheuermann's Kyphosis (SK) is a progressive spinal deformity characterized by abnormal thoracic curvature, with vertebral bodies displaying a wedge-shaped structure. It commonly affects adolescents during growth, leading to chronic pain, aesthetic changes, and functional limitations in severe cases. Early diagnosis and appropriate treatment are crucial to prevent deformity progression and minimize long-term complications. The prevalence of SK ranges from 0.4% to 8%, with genetic and biomechanical factors thought to play a central role in its development. This study reviews the diagnostic and therapeutic approaches for SK, focusing on updated guidelines from major spine societies, including the Brazilian Spine Society (SBC), North American Spine Society (NASS), and European Spine Society (ESS). The findings highlight regional differences in management strategies, with the SBC emphasizing early diagnosis and conservative treatment, the NASS advocating a multidisciplinary approach with surgical intervention for severe cases, and the ESS promoting a cautious approach with an emphasis on pain management and long-term complications prevention. Three clinical cases of surgical intervention are presented, showing successful outcomes following spinal fusion procedures. The study underscores the importance of individualized treatment, incorporating both conservative and surgical options based on the severity and progression of the deformity. Future research is needed to further refine treatment protocols and improve patient outcomes.
Optimizing The Rehabilitation of Patients With Guillain-Barré Syndrome After Diagnosis Through Early Vitamin D Supplementation
Although Guillain-Barré syndrome (GBS) has been known and intensively described for over 100 years, the therapist cannot predict the course of the acute disease, a subsequent autoimmune remission phase or a degenerative late phase after diagnosis. This fact justifies the need to consider an add-on therapy with vitamin D as a therapy option in the context of early rehabilitation in addition to therapy with immunoglobulin G, plasmapheresis/plasma exchange. The pathoimmunological background and the association with 1,25-dihydroxy-vitamin D3, the active metabolite of vitamin D, is shown and conclusions are drawn about daily high-dose vitamin D supplementation from the beginning of diagnosis. This supportive therapy is linked without significant side effects, inexpensive and generally available everywhere. Immunoglobulin G, plasmapheresis/ plasma exchange is not available in all countries at an adequate time, is limited in stock for financial reasons and is used in different ways. The indication will depend on the place of residence of the person with GBS (whether urban or rural), the type of health insurance, the country. In the case of a long period of remission, physical disabilities can remain and have serious effects on everyday professional life and the psyche, especially in young people. Even if the therapeutic success of vitamin D could be limited, the broad spectrum of action of vitamin D on immunopathogenesis, pain symptoms, comorbidity such as anxiety and depression, as well as on the prevention of infection should be exhausted at an early stage in people with Guillain - Barré syndrome. Success will depend crucially on optimal 25-hydroxy vitamin D levels in the blood.
Assessing Autonomic Function in Aging and Disease Using VitalScan
The autonomic nervous system plays a critical role in maintaining homeostasis by regulating vital physiological functions, including cardiovascular, respiratory, and thermoregulatory processes. Autonomic dysfunction, often seen in chronic conditions such as Type 2 Diabetes Mellitus, cancer, and cardiovascular diseases, can lead to severe complications if left undiagnosed and untreated. This review explores the importance of autonomic dysfunction in the context of aging, diabetic autonomic neuropathy and cardiovascular autonomic neuropathy, with a focus on novel diagnostic tools like Heart Rate Variability (HRV) and the VitalScan technology. HRV, evaluated using the VitalScan-ANS system, is emerging as a key marker for evaluating autonomic imbalance, providing valuable insights into cardiovascular health, disease progression, and even early cancer detection. The VitalScan-SudoCheck system, which evaluates sudomotor function, offers a non-invasive, efficient approach for diagnosing early signs of autonomic neuropathy, particularly in individuals with diabetes. Additionally, the review discusses the integration of arterial stiffness indices and Ankle-Brachial Index (ABI), assessed using the VitalScan-Vascular system, to enhance cardiovascular risk assessment. The combination of these diagnostic technologies holds promise for improving early detection, personalized treatment, and patient outcomes. Future research should aim to refine these diagnostic tools, standardize their clinical application, and expand their use across diverse populations to facilitate more effective management of autonomic dysfunction and related complications. Ultimately, this review underscores the need for comprehensive diagnostic strategies to monitor and address autonomic dysfunction, enhancing clinical care for patients with a wide range of chronic conditions.
Prevention of Neurological Damage in Severe Cervical Stenosis: The Role of Intraoperative Monitoring and Proactive Measures
Cervical stenosis is a degenerative condition that causes compression of the spinal cord and nerve roots, resulting in neurological symptoms such as pain, weakness, and loss of motor and sensory function. Surgical treatment, such as spinal decompression, is indicated for severe cases, as untreated compression may lead to irreversible damage. Intraoperative neurophysiological monitoring (IONM) has proven essential for patient safety, allowing early detection of neurological changes and enabling immediate intervention. This article discusses the importance of IONM in severe cervical stenosis surgeries, highlighting preventive measures to minimize neurological damage. We report the case of a 57-yearold patient with severe cervical stenosis associated with myelopathy. A posterior surgical approach was chosen, with decompression and fusion, utilizing IONM to monitor motor potentials. Proactive measures, such as warm saline irrigation and maintenance of a mean arterial pressure (MAP) of 90 mmHg, were implemented to prevent neurological deterioration. After decompression, motor potentials returned to baseline levels, and the patient recovered without new neurological deficits. We conclude that IONM, combined with preventive strategies, is crucial in reducing the risk of neurological damage during severe cervical stenosis surgeries, ensuring greater patient safety.
Intraoperative neurophysiological monitoring
Retrospective Analysis of 52 Cases of Scoliosis Surgery in the Central-West Region of Brazil
This retrospective study analyzed 52 patients who underwent scoliosis surgery between 2014 and 2023 in private hospitals in the Central-West region of Brazil. The objective was to evaluate the degree of curvature correction, using the Cobb method, and postoperative complications. The sample was predominantly female (86.6%), with a mean age of 16 years. The majority of patients (92.3%) were diagnosed with idiopathic scoliosis (IS), with 57.7% presenting thoracic curves and 34.6% presenting lumbar curves, according to the Lenke classification. The average preoperative Cobb angle was 55°, with a postoperative average correction of 74%, reflecting the effectiveness of spinal arthrodesis techniques with pedicle screws. There were no neurological complications, but significant bleeding was observed in three cases, and revision surgery was required in two patients due to postural decompensation. These results are consistent with recent advances in scoliosis surgery, including the use of intraoperative neurophysiological monitoring and more sophisticated instrumentation techniques, such as the CotrelDubousset system. Although highly effective and safe, complications such as blood loss and postural decompensation can occur, requiring continuous monitoring and corrective interventions. This study reaffirms the importance of modern surgical approaches and the high demand for treatment in the region.
Large Abdominal Cerebrospinal Fluid Pseudocyst Complicating Ventriculoperitoneal Shunt: About a Case and Review of the Literature
Background: Ventriculoperitoneal shunting is a simple neurosurgical technique used to treat hydrocephalus, but it is not without complications. One of these is abdominal cerebrospinal fluid (CSF) pseudocysts, which can occur in all age groups, with a highly variable onset time, ranging from a few weeks to several years after drainage. In this article, we report a rare case of abdominal CSF pseudocyst. Case presentation: 9-year-old girl admitted 2 months after ventriculoperitoneal shunt for permanent abdominal pain associated with vomiting and loss of appetite. Clinical examination of the abdomen revealed a voluminous swelling of liquid consistency, not painful to palpation. Abdominal and pelvic CT scans revealed a cystic formation encapsulating the tip of the drain. Surgery consisted of excision of the pseudocyst, evacuation of the fluid and replacement of the bypass drain. The patient made a full recovery. Conclusion: Peritoneal pseudocyst, although rare, is a significant complication of ventriculoperitoneal shunting. Cerebrospinal fluid infection has been identified as its most frequent cause. A multidisciplinary approach is recommended for optimal patient management.
Intracranial Meningeal Hemangiopericytoma: Case Report and Literature Review
Hemangiopericytoma (HPC) is a rare mesenchymal tumor, often located in extracranial areas, and when found in the meninges, it can be mistaken for meningiomas. Intracranial HPC accounts for approximately 0.4% of all brain tumors. These tumors are classified into three types based on biological behavior: benign (Type I), atypical (Type II), and malignant (Type III). Malignant HPCs are characterized by high recurrence rates and metastatic potential. Differential diagnosis between HPC and meningioma is challenging due to similar clinical and radiological features; however, STAT6 immunohistochemical expression is a key marker for differentiation. Imaging techniques such as contrast-enhanced MRI and positron emission tomography (PET) are valuable in preoperative tumor characterization. This report presents a 29-year-old female with recurrent severe headaches and a temporoparietal extra-axial tumor, initially diagnosed as meningioma via imaging. Postoperative histological analysis confirmed the diagnosis of HPC. Despite total surgical resection, the patient experienced local recurrence, requiring further surgical intervention and adjuvant radiotherapy and chemotherapy. HPC is more aggressive than meningioma, with a recurrence rate of 91% and metastasis to various organs. Preoperative embolization can minimize intraoperative bleeding risks due to the tumor's vascularity. Early diagnosis and vigilant postoperative follow-up are critical for improving patient outcomes and managing recurrence and metastasis.
A Criminal Case of Hypersexuality and Parkinson’s Disease
Parkinson’s Disease (PD) is a neurodegenerative disease which has a combination of motor and nonmotor symptoms. The non-motor symptoms pre-dates the appearance of motor symptoms which reflect the deposition of alpha synuclein in regions of the brain which interfered with dopaminergic pathways. Sexual dysfunction is common in PD and hypersexuality is a known impulse control disorder (ICD) secondary to dopaminergic treatment. Hypersexuality as a prodrome to motor symptoms associated with sexual dysfunction is not well described. Consequences of hypersexuality which resulted in criminal acts may not be pardoned based on medical grounds alone.
Noradrenergic Modulation and a Treatment Algorithm for Behavioral Symptoms in Patients with Late Life Dementia
Introduction: Patients affected by neurodegeneration disorders (NDD) often experience difficult to treat disruptive neuropsychiatric symptoms (NPS) i.e. verbal disruption, aggression, psychomotor hyperactivity, sleep difficulties, hallucinations, delusions. The existing treatment algorithms include antipsychotics, gabapentin, trazodone, prazosin, memantine, cholinesterase inhibitors.1,2 Some NPS i.e. anxiety, agitation, aggression, disturbed sleep have been linked to overactivity of the brain noradrenergic system (NAS). The current report suggests a treatment algorithm which includes a method of noradrenergic modulation (NAM). Aims of the study: A. To evaluate a new treatment algorithm for patients with NPS and late life dementia. B. To evaluate the method of NAM in treatment of NPS. Participants and Methods: Nine elderly community dwelling patients (3 males and 6 females) with probable Alzheimer’s dementia and NPS. Age of the patients 71-104 years (86.9, SD 9.4), 4 patients with moderate and 5 patients with severe dementia. Treatment algorithm includes 5 steps and two pathways. Each step is evaluated on the clinical global impression of change (CGI-C) scale. The psychosis pathway (4 patients) begins with an antipsychotic, the alternative pathway (5 patients), with low dose gabapentin (GBP). The psychosis pathway, if ineffective, can switch to the alternative pathway with the add-on of GBP. The alternative pathway proceeds with addition of NAM which includes alpha-1 receptor antagonists (prazosin, doxazosin) and alpha-2 receptor agonists (transdermal clonidine, guanfacine). Results: Treatment was well tolerated. Substantial (7 patients) and moderate (2 patients) improvement in disruptive behaviors such as agitation, aggression, sleep was reflected on the CGI-C scale (score 1.2, SD 0.4), on the Cohen-Mansfeld Agitation Inventory (the score decreased from 52.6, SD 27.0 to 18.6, SD 7.9) and on the de novo introduced VAPS scale (from 8.7, SD 0.4 to 2.7, SD 0.8). The final step of the algorithm, method of NAM was the “game changer” in both psychosis and nonpsychosis alternative pathways. Conclusion: The case series provides preliminary evidence supporting the suggested approach to treatment of NPS in patients with late life dementia.
Integrative and Multi-Disciplinary Treatment for Severe Refractory Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD) is a chronic and complex psychiatric condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions), affecting approximately 2.3% of the global population. This paper presents an integrative and multi-disciplinary treatment approach employed at the Westwood Institute for Anxiety Disorders, directed by Dr. Eda Gorbis. Traditional treatments like Exposure and Response Prevention (ERP) and pharmacotherapy, while effective for many, often leave residual symptoms or fail in treatment-resistant cases. To address these limitations, the Westwood Institute integrates newer modalities such as Mindfulness-Based Behavioral Therapy (MBBT) and cognitive restructuring into a comprehensive treatment framework. We review the current understanding of OCD, emphasizing its varied symptomatology, complex etiology, and significant impact on daily functioning. The importance of thorough assessment and psychoeducation in tailoring individualized treatment plans is underscored, ensuring that all relevant aspects of the disorder are addressed. The integrative model at the Westwood Institute involves a diverse team of healthcare professionals, including psychiatrists, psychologists, exposure coaches, and family therapists, working collaboratively to provide holistic care. This paper aims to provide clinicians with a detailed overview of the integrative treatment strategies utilized at the Westwood Institute, highlighting the potential for improved outcomes in even the most refractory cases of OCD. By combining traditional and innovative therapeutic modalities within a cohesive framework, this approach offers a promising pathway for enhancing the quality of life for individuals living with OCD.
Evaluating Sudomotor Function: Aging, Diabetes, and the Sudomotor Autonomic Neuropathy Index
Assessing sudomotor function is essential for diagnosing and monitoring autonomic disorders, especially in cases of diabetes and small fiber neuropathies. Traditional methods are effective but often complicated and less accessible. Recent innovations, particularly the VitalScan-SudoCheck, provide a non-invasive and rapid alternative for evaluating sudomotor function through techniques such as Quantitative Sudomotor Axon Reflex Test (QSART) and Sympathetic Skin Response (SSR). This study investigates the impact of aging on the risk of developing autonomic neuropathy within a large cohort (n=143,900) using the Sudomotor Autonomic Neuropathy Index (SANI). As individuals age from 20 to 90 years, their SANI scores increase, reflecting a higher risk of autonomic neuropathy. Additionally, the study evaluates the effectiveness of the SANI score in detecting diabetic neuropathy compared to clinical diagnoses made by healthcare professionals for patients with type 2 diabetes mellitus (T2DM). The findings reveal that T2DM patients (n=2,560) have higher SANI scores than the elderly cohort aged 80 to 90. The SANI, developed by SudoCheck, facilitates comprehensive monitoring of autonomic health, particularly among older adults. Despite these encouraging findings, further research is necessary to standardize sudomotor function tests and enhance their clinical utility. By addressing the barriers to the adoption of sudomotor assessments, this study highlights the importance of timely diagnosis in improving patient outcomes and managing the economic impact of diabetes-related complications.
Aphasia, a language deficit caused by an acquired cerebral lesion was initially believed to be triggered exclusively by cortical damage. However, recent findings have confirmed that aphasia can also arise from subcortical lesions. This paper presents a case of a 53-year-old man with acquired language impairment associated with a lesion in the left lenticular nucleus caused by a hemorrhagic cerebrovascular event. The patient exhibited clinical and imaging characteristics consistent with subcortical aphasia of the thalamic and striato-capsular type. Subcortical structures are increasingly recognized for their involvement in language processing, alongside the cerebral cortex. Despite current acceptance of subcortical aphasia, there are limited studies on this type of aphasia and its interlinguistic variations. Consequently, extensive research is warranted to gain a better understanding of it as a clinical entity.